Ankle Arthroscopy | Tri-County Orthopedics

Ankle arthroscopy is a minimally invasive surgical technique that utilizes the technology of fiberoptics, magnifying lenses, and digital video monitors to allow the surgeon to directly visualize the inside of an ankle through small incisions. Several incisions, approximately half a centimeter in length, are fashioned about the ankle to allow for the insertion of an arthroscope, or small fiberoptic video camera, and/or special arthroscopic instruments. Sterile fluid is also circulated through the ankle to distend the joint, creating more space for the arthroscope and instruments. This also allows for better visibility within the ankle, space to maneuver instruments, and clearance of debris.

How is Ankle Arthroscopy Performed?

Ankle arthroscopy is generally performed as an outpatient surgery under general anesthesia with or without a regional pain block or epidural anesthetic with sedation. After adequate anesthesia is established, a tourniquet is applied to the leg, and the leg is prepped and draped in a sterile fashion. Mechanical distraction devices are sometimes used to help surgeons temporarily enlarge the potential space of the ankle. After the foot and ankle are appropriately positioned, at least two approximately 0.5mm incisions are made in the ankle. These incisions become the entry sites into the ankle, or portals, for the arthroscopic camera and instruments. These portals are placed strategically in an effort to avoid vessels and nerves. The incisions are made in the front or back of the ankle, or a combination of these. Sterile fluid is then allowed to flow through the ankle to further open the joint. The camera and instruments can then be exchanged between portals to perform the surgery. At the conclusion of the procedure, small sutures are placed in the skin to close the portals. A sterile compressive dressing, and sometimes a splint or boot, are then applied. The patient is brought to the recovery area and is usually discharged home the same day with specific weightbearing and dressing care instructions.

What conditions is ankle arthroscopy used to treat?

Ankle arthroscopy can sometimes be used as an alternative to open ankle surgery, which is a surgical approach utilizing larger incisions to access the inside of the ankle. It can be used to diagnose and treat different disorders of the ankle joint.

The list of problems that this technology can be used for is constantly evolving, but includes:

1. Osteochondral defect of the talus (also referred to as osteochondritis dessicans, OCDs, osteochondral fractures)

This includes acute ankle sprains and repetitive ankle injuries caused by chronic instability. Atraumatic causes of OCDs include vascular insults, genetic predisposition, degeneration, and metabolic abnormalities. Patients will often present with complaints of persistent and progressive ankle pain and swelling. This can be associated with mechanical symptoms of catching, clicking, or popping, and decreased range of motion. The diagnosis is made with the combination of physical exam and diagnostic imaging, including X-rays, MRI, and/or CT scan. The treatment will be based on the size and location of the OCD, associated symptoms, patient demographics, and activity demands of the patient. After the diagnosis is made arthroscopically, treatment options include microfracture, subchondral drilling, abrasion arthroplasty, fragment fixation, and bone grafting procedures. Thorough discussion with your surgeon is necessary to determine which option is most appropriate for you.

2. Anterior Ankle Impingement (also referred to as “athlete’s ankle” or “footballer’s ankle”) and Anterolateral Ankle Impingement

These occur when either bone and soft tissue of the anterior (the “front”) ankle joint becomes inflamed due to repetitive stress or irritation. This will cause pain in the ankle joint, swelling, and can limit motion of the ankle, especially dorsiflexion (loss of the ability to bend your “toes towards your nose”). Walking uphill is often painful. This is common in soccer players and any athlete with recurrent ankle sprains. The diagnosis of anterior ankle impingement can be made by identifying osteophytes, or “bone spurs,” on standard X-rays of the ankle. Sometimes, a MRI is necessary if bone spurs are not present. MRI can identify redundant and inflamed soft tissue in the anterolateral gutter of the ankle not seen with standard X-rays. This is considered anterolateral ankle impingement. If nonoperative measures fail to relieve symptoms of either of these conditions, ankle arthroscopy can be used to shave away redundant soft tissues and/or bone spurs.

3.  Posterior Ankle Impingement

This occurs when the bone and soft tissue of the hindfoot (the “back” of the ankle) becomes inflamed due to repetitive stress. This will cause pain in the ankle joint, swelling, and often times limited motion of the ankle, especially plantarflexion (loss of the ability to “press on the gas”). This overuse syndrome occurs most commonly in ballet dancers, but can also be seen in other athletes. Like anterior ankle impingement, it is usually associated with bone issues in the posterior part of the ankle (the “back” of the ankle). It can also be associated with an accessory bone, which is not found in all patients that is referred to as an os trigonum.  Surgical treatment involves placing arthroscopic incisions in the back of the ankle to access the painful area. Bone spurs, inflamed soft tissue, and if present, the os trigonum, can then be removed arthroscopically.   

4.  Synovitis

Synovitis is inflammation of the soft tissue lining of the ankle joint (synovium) that will often manifest as pain, swelling, and loss of motion. This can occur due to an acute trauma, inflammatory arthritis (i.e. rheumatoid arthritis), overuse, and degenerative joint disease (osteoarthritis). If nonsurgical treatment options fail to provide relief, ankle arthroscopy can be used to surgically remove inflamed synovium.

5.  Loose Bodies

Articular cartilage and/or scar tissue following trauma to the ankle can become free floating in the joint and form what is referred to as a “loose body”. These can also occur within the setting of a condition called synovial chondromatosis, where the lining of the joint becomes redundant for unexplained reasons. These loose bodies can cause problems such as clicking, catching, and frank locking that often lead to pain, swelling, and loss of motion. Occasionally loose bodies can be identified with standard X-rays or a CT scan, but frequently require an MRI to visualize the culprit. Ankle arthroscopy can be used to find and remove the loose body.         

6.  Arthrofibrosis

Sometimes, previous trauma, prior ankle surgery, infections of the ankle joint, and inflammatory arthritides, such as rheumatoid arthritis, predispose patients to the development of scar tissue, or arthrofibrosis. Ankle arthroscopy can be used to identify this scar tissue and remove it.      

7.  Infection

Septic arthritis, or infection of the joint space, cannot be treated effectively with antibiotics alone. It often necessitates an urgent surgery to wash out the joint. This can be done as an open procedure or with an arthroscopy. Although infections of the skin and soft tissue around the ankle joint preclude ankle arthroscopy in most settings, septic arthritis can be an indication for ankle arthroscopy. The decision of whether or not an infection is amenable to arthroscopic surgery is determined by many factors. Only you and your surgeon can determine whether or not it is appropriate for you.        

8. Ankle Fractures

Ankle arthroscopy can also be used along with conventional techniques of fracture repair to ensure that normal anatomic alignment of cartilage within the ankle is restored. This is done to help minimize the risk of future posttraumatic arthritis. 

9.  Unexplained Ankle Symptoms

Occasionally patients develop symptoms, such as pain, swelling, locking, catching, grinding, or popping, that cannot be explained with diagnostic techniques such as X-rays, CT scans, MRIs, or bone scans. When nonoperative measures have been exhausted, ankle arthroscopy can be used to diagnose lesions within the ankle joint. It provides the opportunity to look directly into the joint, identify potential problems, and definitively treat many of them.

10.  Tibiotalar Arthritis

Ankle fractures, infection, osteonecrosis, and arthritis may eventually lead to chronic pain and stiffness that can not be controlled with nonoperative measures. Ankle fusion is a treatment option appropriate for many patients in this situation. When performed by an experienced surgeon, ankle arthroscopy offers a minimally invasive way to perform ankle fusion that may yield results that are equal to or better than conventional open techniques. This procedure has its limitations. Your surgeon can determine if this procedure is an appropriate option for you.    

Recovery: How Do I Care for My Ankle After Surgery?

This will ultimately depend on the type of problem and nature of the arthroscopic procedure used to treat the problem. Patients can expect pain and swelling following surgery that necessitates elevation of the leg and oral pain medication for at least several days. The type of procedure performed will determine whether or not your ability to bear weight on the affected leg will be restricted after surgery. This can range from progressive immediate weightbearing with crutches, to a period of strict nonweightbearing for one to two months. If ankle arthroscopy is used as an adjunct to conventional fracture fixation, this period of nonweightbearing may be longer depending on your body’s ability to heal the fracture. Your dressing will be left in place until follow-up with your surgeon, and sutures will be removed one to two weeks after surgery. Active range of motion is generally allowed immediately. After the swelling and soft tissue reaction subsides, a progressive strengthening routine may be implemented. It will be up to your surgeon when each of these activities is allowed and whether or not a formal physical therapy referral is necessary.   

Outcomes

Many factors will contribute to the outcome of your ankle arthroscopy procedure. These include, but are not limited to your expectations, the severity of your condition, complexity of the procedure performed, as well as postoperative compliance, rehabilitation, and motivation. The literature shows that an average of greater than 70-90% of patients undergoing ankle arthroscopy for the most common indications achieve good or excellent results.

What Are the Advantages of Ankle Arthroscopy?

Ankle arthroscopy makes possible direct visualization of the inside of the ankle without large cosmetically unsightly scars. It minimizes other problems encountered with large incisions around the ankle, such as pain, bleeding, wound breakdown, and infection. The procedure can be performed as an outpatient because of its minimally invasive nature. Patients may be able to begin rehabilitation sooner, rehabilitate more functionally, and return to high level activities, such as sports.

Who Is Not Eligible for Ankle Arthroscopy?

Elective arthroscopy is contraindicated in patients with soft tissue infections of the ankle such as cellulitis, acute and chronic open wounds, and dermatitis overlying the ankle. Patients with severe arthritic changes with loss of the joint space are not good candidates for arthroscopic debridement procedures. Patients with severe peripheral vascular disease, peripheral neuropathy, reflex sympathetic dystrophy/complex regional pain syndrome, and edema may not be eligible for ankle arthroscopy. It is important to thoroughly discuss your individual risks, potential benefits, and the alternatives to ankle arthroscopy with your surgeon.

Complications

Potential complications of ankle arthroscopy include, but are not limited to injury to nerves, vessels, tendons, ligaments or cartilage about the ankle, deep and superficial infections, scarring, reflex sympathetic dystrophy/complex regional pain syndrome, missed diagnoses, broken instruments, and anesthetic complications. It is important to attend follow-up appointments with your surgeon following surgery as recommended.

The following symptoms should be urgently reported to your surgeon, as they may be an indication of a complication:

• Pain not controlled by pain medication
• Constitutional symptoms including nausea, vomiting, fevers, or chills
• Wound redness, swelling, warmth or drainage
• New numbness, weakness, or tingling.

Frequently Asked Questions:

When Can I Safely Return to Driving?

This will be determined by the type of procedure you undergo and your surgeon’s evaluation of your progress. When you are able to bear weight without limitation and are no longer taking narcotic pain medication, you will likely be cleared to return to driving. This can be as soon as several days after surgery or may take one to two months.

When Can I Expect to Return to Work/Sports?

This will be determined by the type of procedure you undergo and your surgeon’s evaluation of your progress. If your mobility allows you to safely complete your job duties, there is the possibility of returning to work several days after surgery. Most patients can expect to be out of work for at least one to two weeks while they recover. It is possible to return to high level sports following ankle arthroscopy. This will depend on your ability to protect yourself effectively and perform during your particular sporting activity. Athletes could be cleared to return to play at as early as one to two weeks, but in all likelihood can expect an excess of four to six weeks.

_{*Source:  American Orthopaedic Foot & Ankle Society® http://www.aofas.org}

Ankle Arthroscopy – Auckland Joint Surgeon

What is Ankle arthroscopy?

Ankle arthroscopy is sometimes called an “ankle scope” or “keyhole surgery”. The procedure involves making two small incisions (less than 1cm long) on the front of the ankle to create portals. A small telescopic camera (‘scope’) is inserted into one of the portals and this provides a view inside the ankle joint. The other portal is used for passing in small surgical instruments.

In addition to being able to directly assess the cause of ankle pain, there are many procedures that can be performed using arthroscopic technique including:

• Repair or removal of fragments of loose cartilage and microfracture

• Removal of bony ankle spurs causing impingement (catching)

• Removal of loose bodies

• Debridement of scar tissue

• Assessment of ligament instability between tibia and fibular bone – ‘high’ ankle sprain

Microfracture is a procedure performed when there is articular cartilage loss following an injury and the underlying bone is exposed. In the procedure, small perforations are made in the exposed bone to induce new cartilage formation to cover the bone. Postoperatively this requires a period of touch weight bearing (using crutches ) to protect the area for 4-6 weeks .

What are the risks of ankle arthroscopy?

Arthroscopy is a quick and effective procedure. The majority of surgeries go very smoothly without any major complications.

There may be a degree of ongoing pain if there is a large area of articular cartilage loss

Commonly, patients experience swelling around the ankle, which can take several weeks to settle.

Occasionally patients experience some transient numbness around the portals (incisions)

Serious complications such as infection and blood clots are very rare.

How long does ankle arthroscopy take?

Simple arthroscopy takes about 30-50 minutes to perform. The joint is visually examined, and pictures/video inside the joint are taken. If there are extensive bony spurs and scar tissue it can take longer.

Generally, arthroscopy is performed as Day Stay Surgery and you may go home the same day as your procedure.

It is often performed with ankle stabilisation surgery. This will double the length of the operation.

You will need someone to drive you home, and a responsible adult to be with you overnight as you may still be sleepy and require oral pain medications.

What Happens on the day of surgery?

DO NOT EAT OR DRINK from midnight, unless otherwise instructed.

Dr Schluter will meet with you, answer any further questions, check the consent form and mark the operative leg. You will also meet the anaesthetist (specialist doctor) who will be providing the anaesthetic. In most cases the procedure is done under a general anaesthetic. An IV line (drip) will be inserted and you may be given some premedication.

What should I expect immediately after the operation?

After the operation you will go to the recovery room where nursing staff will monitor you until you are awake. You are likely to have a cast over your ankle made of Plaster of Paris (known as a backslab) and wrapped in a crepe bandage. This is to keep the ankle immobilised but you will also required crutches to prevent you putting weight through the operated foot. I also recommend hiring a knee scooter if you are non weight bearing for longer than 2 weeks kneescooters.co.nz 0800395395

As you wake up you may experience discomfort or a tight/full feeling in the ankle, which should be easily managed with pain medication. Once you are alert, you will be encouraged to get up and mobilise slowly. Once you can mobilise safely you will be ready for discharged home.

What follow up should I expect?

Dr Schluter will review you at a follow up appointment 1- 2 weeks after your surgery. He will review your wounds and remove any sutures that are not dissolvable. You will be able to discuss the findings of the arthroscopy and talk through any photos/video taken during the procedure.

At this appointment, Dr Schluter will also discuss your ongoing rehabilitation programme.

How do I look after my ankle when I get home?

For the first 5 – 7 days it is very important to elevate the leg when you are resting. Rest is important to allow the swelling and inflammation to settle.

As arthroscopy of the ankle is often performed in addition to other procedures, this may also contribute to the swelling and discomfort. Because your foot is immobilised in the backslab it should not be too painful. You cannot get the cast wet so when showering will need to cover the backslab with a plastic bag.

You will have the dressings changed, wound checked and fitted into a moonboot at the first clinic appointment. Whether you can then weight bear from then will depend on the surgical procedure but you can shower out of the moonboot so long as the wound(s) has a waterproof dressing over it.

Leave the moonboot on at all times (including in bed at night) until instructed to take it off.

You cannot drive with a moonboot on the right leg. You can drive with a moonboot on the left leg if you have an automatic after 3-4 weeks post surgery, but it is not recommended for long trips. Avoid flying for the first 6 weeks if possible because of swelling and risks of blood clots.

My ankle is still swollen, is this normal?

It is quite normal to have swelling, bruising, clicking and discomfort in your ankle for 6 – 8 weeks after the operation. These ongoing symptoms are generally related to the underlying condition of the ankle, the extent of the surgery and the amount of activity you have been doing.

If you are concerned about any of these symptoms please discuss them with Dr Schluter at the clinic visit.

What if I have concerns after my surgery?

Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:

• Heavy bleeding from the incision or the incision opening up

• Sudden severe pain or tenderness at the wound site or in the joint.

• Swelling in the calf or thigh, especially if associated with pain or heat

• Redness around the incision that continues to spreads.

• Temperature higher than 38. 5 °C (fever) or chills.

• Any concerns you may have regarding your recent surgery

Arthroscopy of the ankle | healthdirect

On this page

This page will give you information about an arthroscopy of the ankle. If you have any questions, you should ask your GP or other relevant health professional.

What is an arthroscopy of your ankle?

An arthroscopy (keyhole surgery) allows your surgeon to see inside your ankle using a camera inserted through small cuts on your skin. Your surgeon can diagnose problems such as damage to the joint surface or ligaments, and arthritis.

What are the benefits of surgery?

The aim is to confirm exactly what the problem is and for many people the problem can be treated at the same time.

Are there any alternatives to surgery?

Problems inside your ankle can often be diagnosed using a magnetic scan (MRI scan) but you may then need an arthroscopy to treat the problem.

An arthroscopy of the ankle.

What does the operation involve?

Various anaesthetic techniques are possible.

The operation usually takes 30 to 45 minutes.

Your surgeon will examine your ankle ligaments while you are under the anaesthetic and your muscles are completely relaxed. They will insert a small camera through one or more small cuts around your ankle.

They will wash out any loose material caused by wear of the joint surfaces. Your surgeon will remove any spurs of bone or swelling of the lining of your ankle joint.

If you have torn your ankle ligaments, you may need a reconstruction operation.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• pain
• bleeding
• difficulty passing urine
• unsightly scarring of your skin
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• blood clot in your leg
• blood clot in your lung

Specific complications of this operation

• compartment syndrome, where the calf muscles swell and get tight
• infection in your ankle joint
• severe pain, stiffness and loss of use of your ankle
• damage to nerves around your ankle

How soon will I recover?

You should be able to go home the same day.

It is common for your ankle to be a little swollen for a few weeks.

Walking can be uncomfortable and you may need to take painkillers to help relieve your pain.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery and can return to normal activities.

Summary

An arthroscopy allows your surgeon to diagnose and treat some common problems affecting your ankle, without the need for a large cut on your skin. This may reduce the amount of pain you feel and speed up your recovery.

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Ankle Arthroscopy Rehabilitation

Read What Mr Gordon’s Patients Are Saying

Arthroscopy is a type of keyhole surgery where the internal structures of a joint is examined for diagnosis and treatment. This is in contrast to an ‘Open’ procedure, involving a much larger incision. During the examination, one or more small incisions are made in the skin through which pencil-sized instruments and a fibre optic camera (arthroscope) are passed. The arthroscope is attached to a high definition monitor which displays the interior of the joint as a magnified image.

Mr Gordon is a strong believer that key hole surgery produces excellent results with a faster return to activity than traditional ‘open’ methods and where possible, utilises these techniques. He has undertaken specific training at internationally renowned centres and teaches and lectures on arthroscopic techniques.

Ankle arthroscopy can be used in diagnosis and treatment of many conditions including:
Injuries to the cartilage (microfracture)
Removing excessive scar tissue impingement
Removing abnormal bone growth due to repeated injury eg. ‘Footballers ankle’
Removing loose bodies of bone or cartilage that cause pain or locking
Fusion of an arthritic ankle joint
Removing synovitis (inflammation of the lining of the ankle joint)

Risks of Arthroscopic Surgery
Although rare, complications can occur, these include (but not limited to) infection and nerve injury

Recovery
This is usually Day Case surgery (no overnight stay). Puncture wounds take 2 weeks to heel. A rehabilitation program will be advised for a speedy recovery of normal joint function.

Going Home After Surgery
You can walk after the operation as soon as you are comfortable, which is normally within a few hours. Once you have been assessed by a physiotherapist or nurse and are deemed safe (with or without crutches), you can go home the same day. Someone will need to pick you up.

Weight Bearing Status and Elevation
Mr Gordon will advise you on your weight bearing status and length of elevation (in days) as this will depend on the type of surgery you have had

Day of the Operation at Home
You may experience some discomfort and should take pain killers, such as Codeine with Diclofenac. These should be taken regularly (3-4 times/day) especially before physiotherapy or exercise sessions. There may be some swelling in the ankle and if so, place ice (or frozen vegetables) on the ankle for 10 minutes in every hour, especially before and after physiotherapy or exercise sessions.

Day after the Operation, Bandage, Dressings and Showering
48 hours after the operation, you can remove the bandage, wool and gauze around the ankle yourself. Underneath will be 2 waterproof dressings. There may be some blood staining on the dressings, this is normal. Keep the dressings dry for 3 whole days after the operation. On the 4th day you can have a shower, taking care not to soak the dressings although they can get wet. Avoid a bath until Mr Gordon has seen you in clinic at 10 days to 2 weeks to review your wounds. Once you have removed the bandage, you can wear a normally shoe.

Physiotherapy and Exercise
Adhere to your weight bearing status detailed above. You are encouraged to perform the Rehabilitation Exercises detailed below, as much as you feel comfortable. Exercise should start as soon as you are comfortable, on the day of surgery. More formal exercises or dedicated physiotherapy may commence 2 weeks after the operation if required.

Driving
You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe after a few days post operatively. For right sided surgery, driving is probably safe at 2 weeks post operatively, unless you are non weight bearing. You should check with your insurance company. If you are unsure, please ask Mr Gordon.

Returning to Work
This will depend on exactly what has been performed and how you are following surgery
Sedentary jobs: Return after 3 days
Standing/walking jobs: Return after 2 weeks, but may be sooner depending on comfort and swelling
Manual/labouring jobs: Return after 2-4 weeks, but may be sooner depending on comfort and swelling

Out Patient Visits to see Mr Gordon
2 weeks – to assess wound healing
6 weeks – to assess pain, swelling, muscle bulk and range of motion
12 weeks – to assess pain, swelling, muscle bulk and range of motion and to advise on increasing activity level
4-6 months – final review depending on progress

Rehabilitation Exercises – to be done every 2 hours

1. Active Circumduction
Rotate the foot so the toes ‘draw’ a circle in the air, clockwise and anti-clockwise
20 circles over 60 seconds

2. Active Ankle Dorsiflexion (foot up) and Plantarflexion (foot down)
Move foot up and down (1 repetition)
Repeat 20 times over 60 seconds

3. Triple Flexion/Extension (hip, knee, ankle)
Bring knee toward chest bringing foot and ankle up
Straighten leg, pointing toes
Repeat 30 times

The following should NOT be done if Non Weight Bearing

4. Static Strengthening of :
4a: Invertor muscles (DO NOT DO IF NON WEIGHT BEARING)
Push both feet together and hold for 10 seconds
Repeat 5 times

4b: Evertor muscles (DO NOT DO IF NON WEIGHT BEARING)
Cross legs over
Push both feet together and hold for 10 seconds
Repeat 5 times
Swap over feet

4c: Dorsiflexion and Plantarflexion muscles (DO NOT DO IF NON WEIGHT BEARING)
Place once foot over the other
Push up with lower foot, resisted by upper foot
Hold for 10 seconds
Repeat 5 times
Swap over feet and repeat

5. Triceps Surae Stretch (DO NOT DO IF NON WEIGHT BEARING)
Place feet apart and put hands on a wall
Have injured leg toward the rear
Keep feet in place on ground
Lean forward, keeping the heel of the rear (injured) foot on the ground
Hold for 20 seconds
Repeat 3 times
Swap feet

Read What Mr Gordon’s Patients Are Saying

Arthroscopic Surgery – Sarasota, FL: Florida Orthopedic Foot & Ankle Center

 Arthroscopy is surgery that uses a tiny camera and surgical tools to examine or repair the tissues inside or around your ankle and other joints within the foot. The camera is called an arthroscope. The procedure allows the surgeon to detect problems and make repairs without making larger cuts in the skin and tissue. This means that you may have less pain and recover more quickly than open surgery.

Portal placement for anterior ankle arthroscopy. Note how small the incisions are.

Description

Most patients will have regional anesthesia during the procedure. Your leg and ankle area will be numbed so that you do not feel any pain during the procedure and for several days after. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.  Patients do not feel, see, hear or remember anything during the procedure!

During the procedure, the surgeon does the following:

Inserts the arthroscope into your joint through a small incision. The scope is connected to a video monitor in the operating room. This allows the surgeon to view the inside of your joint and

inspects all the tissues of your joint. These tissues include cartilage, bones, tendons, and ligaments.

What are the indications for Ankle and Foot arthroscopic surgery?

Ankle arthritis: Ankle fusion is a treatment option appropriate for many patients with end-stage ankle arthritis. Ankle arthroscopy offers a minimally invasive way to perform ankle fusion. Results can be equal to or better than open techniques.

Arthroscopic Ankle Fusion. All cartilage is removed with arthroscopic instrumentation and the joint is fused with screws that can be placed through the skin with extremely small incisions.

Ankle fractures: Ankle arthroscopy may be used along with open techniques of fracture repair. This can help to ensure normal alignment of bone and cartilage. It may also be used during ankle fracture repair to look for cartilage injuries inside the ankle which often occur.  Dr. Cottom will often include a scope when he fixes ankle fractures as there is a high incidence of cartilage damage as well.

The scope is used to help achieve perfect reduction of a distal tibial fracture.

Ankle instability: Ligaments of the ankle can become stretched out, which can lead to a feeling that the ankle gives way.  This can also cause abnormal loading of the joint and damage to cartilage and other structures around the ankle.  Dr. Cottom has helped pioneer surgical techniques for these problems and has published several papers on the “All-Inside” Arthroscopic Brostrom Procedure in peer reviewed journals.

Anchor placement in the fibula for an “All-Inside” Arthroscopic Brostrom Procedure

Anterior ankle impingement: Ankle impingement occurs when bone or soft tissue at the front of the ankle joint becomes inflamed. Symptoms include ankle pain and swelling. This can limit the motion of the joint and can often be very painful.

Impingement band across the anterior lateral talus. This can cause pain and can damage the cartilage within the joint.

Arthrofibrosis: Scar tissue can form within the ankle. This can lead to a painful and stiff joint. This is known as arthrofibrosis. Ankle arthroscopy can be used to identify the scar tissue and remove it.

Arthrofibrosis in the anterior lateral ankle joint as a result of chronic lateral ankle instability.

Infection: Infection the joint space cannot be treated with antibiotics alone. It often requires an urgent surgery to wash out the joint. This can be done with arthroscopy in some cases.

Loose bodies: Cartilage, bone and scar tissue can become free floating in the joint and form what is referred to as loose bodies. Loose bodies can be painful and can cause problems such as clicking and catching.  They can also damage healthy cartilage.  Locking of the ankle joint may occur. Ankle arthroscopy can be used to find and remove the loose bodies.

Osteochondral defect (OCD): These are areas of damaged cartilage and bone in the ankle joint. OCDs are usually caused by injuries to the ankle such as fractures and sprains. Common symptoms include ankle pain and swelling. Patients may complain of catching or clicking in the ankle. The diagnosis is made with a combination of a physical exam and imaging studies. Imaging may include X-rays, MRI or CT scan. The treatment is based on the size, location and stability of the OCD. The patient’s symptoms and activity demands are also considered. Surgery often consists of scraping away the damaged cartilage and drilling small holes in the bone to promote healing. Bone grafting and cartilage transplant procedures are often performed by Dr. Cottom.  Technology has allowed us to use dehydrated cartilage and repair these lesions with excellent long term outcomes.

Osteochondral lesion of the talus. Note how the cartilage is lifted off the bone.

Posterior ankle impingement: This occurs when the soft tissue at the back of the ankle becomes inflamed. Pointing the foot down can be painful. This overuse syndrome occurs commonly in dancers. It can be associated with an extra bone called an os trigonum. The problem tissue can be removed with arthroscopy and if there is any irritation to the FHL tendon, it can be addressed at the same time.

CT Scan showing a loose body in the joint and an os-trigonum.

C-Arm shot of arthroscopic instrumentation in the posterior aspect of the ankle joint.

Synovitis: The soft tissue lining of the ankle joint (synovial tissue) can become inflamed.  This causes pain and swelling. It can be caused by injury and overuse. Inflammatory arthritis (rheumatoid arthritis) and osteoarthritis can also cause synovitis. Ankle arthroscopy can be used to surgically remove inflamed tissue that does not respond to nonsurgical treatment.

Synovitis causing pain within the ankle joint.

Generalized ankle Pain: Occasionally patients develop symptoms that cannot be explained by other diagnostic techniques.  We will often inject the joint which provides valuable information on a patients given problem.  These injections are done in the office and are both diagnostic and theraputic.  Arthroscopy is also an option that provides the opportunity to look directly into the joint. The surgeon can then identify problems that may be treated with surgery.

At the end of the surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and what repairs they made.

Note how small the incisions are in this image. This is after an “All-Inside” Arthroscopic Brostrom Procedure.

Arthroscopy of the Subtalar and Small Joints of the Foot

The subtalar joint is located under the ankle joint.  It is the joint between the talus (on top) and the calcaneus or heel bone (on the bottom).  Arthroscopic procedures can also be performed within this joint similar to the ankle joint.  Dr. Cottom uses a smaller scope in these cases as the joint is much smaller than the ankle.  Arthritis, loose bodies, synovitis, pain, impingement, fusion, assisted fracture reduction and osteochondral lesions are all conditions amenable to this type of surgery in the subtalar and smaller joints of the foot.  At Florida Orthopedic Foot & Ankle Center, we have the experience that is required in these technically challenging smaller joint arthroscopic procedures.

Arthroscopic view of the subtalar joint.

C-arm image of arthroscopic instruments in the subtalar joint. This patient is undergoing an arthroscopic subtalar joint fusion.

Synovitis in the great toe joint. This patient had a chronic plantar plate tear or “turf toe” injury. Note how red and inflamed the tissue is.

Before the Procedure:

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.

Ask your provider which medicines you should still take on the day of your surgery.

If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.

Tell your provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.

If you smoke, try to stop. Ask your health care provider or nurse for help. Smoking can slow wound and bone healing.

Tell your doctor about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

On the day of surgery:

Follow instructions about when to stop eating and drinking before the procedure.

Take the medicines your provider told you to take with a small sip of water.

Follow instructions about when to arrive at the hospital. Arrive on time.

After the Procedure:

You can usually go home the same day after you recover from the anesthesia. You should have someone drive you home.

Keep your ankle elevated above your heart for 2 to 3 days to help reduce swelling and pain. You can also apply cold packs to reduce swelling.

Keep your bandage clean and dry. Follow instructions for how to change the dressing.

You can take pain relievers, if needed, as long as your doctor says it is safe to do so.

You will need to use a walker or crutches and keep weight off your foot. 

Advantages of Arthroscopic Surgery:

Arthroscopy uses small cuts in the skin. Compared to regular surgery, you may have:

• Less pain and stiffness
• Fewer complications
• Faster recovery

The small cuts will heal quickly, and you may be able to resume your normal activities in a few days. But, if a lot of tissue in your ankle had to be repaired, it may take several weeks to heal. How quickly you heal depends on how complicated the surgery was.

You may be shown how to do gentle exercises as you heal. Dr. Cottom will almost always recommend that you see a physical therapist to help you regain the full use of your lower extremity after your procedure.

Ankle Arthroscopy – Foot HealthCare Associates

Technology and unique instrumentation have led to the development of surgical techniques for the diagnosis and repair of joint disorders. Knee arthroscopy was developed in the late 1960’s. Small joint arthroscopy was developed in the early 1980’s by orthopedic and podiatric surgeons and adapted to foot and ankle joints. Your podiatric surgeon may identify a potential problem with a foot or ankle joint after examining the lower extremity. Ankle Arthroscopy may be recommended to confirm a diagnosis or perform a surgical procedure within a joint using an arthroscopic instrument.

For example, needle-like probes enter the joint through a small opening of the skin. The podiatric surgeon introduces a tiny camera to inspect the joint. The podiatric surgeon may also insert surgical instruments through another small incision to perform additional procedures within the joint. Unlike traditional joint surgery that requires large incisions to expose the joint, arthroscopy uses small openings to examine the joint. By eliminating the need for large incisions, arthroscopy reduces the risk of infection and swelling. Podiatric surgeons may perform arthroscopic surgery in hospitals, outpatient surgery centers and in their offices. Arthroscopy is often a “same day” procedure allowing the patient to return home after surgery. Your podiatric surgeon will discuss all aspects of surgery with you.

Instrumentation

Podiatric surgeons use delicate instruments and miniature video cameras to perform arthroscopic surgery. These instruments include cutting tools, burrs, graspers, shavers, fastening tools, sutures, laser and electrocautery to control bleeding. Arthoscopic techniques allow for a variety of procedures that are performed on foot and ankle joints. The following table reflects conditions for which the arthoscope can be used to diagnose and perform reconstructive procedures.

CONDITION ARTHROSCOPIC TREATMENT

Chronic Ankle Pain Diagnosis, biopsy
Arthritis Biopsy, arthroplasty, fusion
Loose bodies Excision
Ankle instability (the feeling of giving way) Ligament repair
Cartilage fractures, chrondromalacia Cartilage repair or removal
Meniscoid body (scar tissue) Excision, biopsy
Advantages of arthroscopic surgery include reduced trauma due to the small instruments used. Small instruments cause less damage to surrounding skin, ligaments, tendons and bony structures. Movement of the joint reduces swelling, stiffness, and postoperative discomfort. Your podiatric surgeon may recommend exercising the joint to hasten your recovery to bathing, walking, and sports activity.

Postoperative Care

Your podiatric surgeon may recommend rest, ice, compression, and elevation (“RICE”) to help speed healing.
REST: Ask your podiatric surgeon how long you should rest or restrict activity.
ICE: Ice reduces swelling, bleeding and pain following surgery.
COMPRESSION: Dressings help reduce swelling and stabilize the joint, preventing unnecessary motion. Dressings should be snug but should not interfere with proper circulation.
ELEVATION: Keep the foot at or above the level of your heart to drain excess fluids away from your foot. This helps to reduce swelling and discomfort.

Summary

Arthroscopy allows your podiatric surgeon to look directly into your ankle and reach a more accurate diagnosis. Additional benefits of arthroscopy include a shortened postoperative course and rapid recovery.

Ankle Arthroscopy Washington DC | Ankle Arthroscopic Surgery DC

What Happens During the Procedure?

Depending on your condition and unique needs, you will either need general or local anesthesia. This will be decided at your consultation so you will know in advance how you need to prepare.

During the procedure, Dr. Stein  will make a small cut in your foot. A small, thin tool called an arthroscope will be inserted into the small incision. The device has a camera lens and a light that allows the doctor to see inside your ankle joint. The image can be seen in real-time as the camera is projected onto a screen during the process. Once inside, the doctor will diagnose the issue and decide what surgery is needed. It may be done at the same time with certain attachments, meaning that the doctor can both diagnose and complete the necessary treatment at the same time. After the tool is removed, Dr. Stein will close up your cut.

Ankle Arthroscopy is almost always an outpatient surgical procedure. Below you will find the benefits of this surgical procedure.

• Minimal risk
• Fewer complications (as compared to an “open” procedure)
• Decreased pain after the operation
• Reduced recovery time
• Less scarring

Recovery Time and Aftercare

You will likely have some pain after the procedure. You should take all prescribed medications after and contact us if you have a fever, pain that gets worse, significant swelling, numbness, or issues with your wound. Depending on the amount of pain you have, you may need crutches to assist you during the first few days of recovery. The benefit of this procedure is that patients report less pain than if they had open surgery. It also takes less time as it is less invasive.

One of the significant aspects of recovery is taking care of the wound from the incision. You will need to keep the area as dry as possible as it heals. If you shower, you will need to cover your foot with a plastic bag. Do not bath and let your foot go into the water. The stitches are usually removed around one to two weeks after surgery. We will let you know the specific steps for how to take care of your wound once you leave and before you come back for the follow-up appointment.

You can usually go back to work or school within three to five days. However, full recovery usually takes a few weeks to feel back to normal. We will provide you with a list of activities you can and cannot do during your recovery period.

Ankle Arthroscopy in Washington, D.C.

Dr. Stein is a board-certified orthopedic surgeon with a specialty in foot and ankle orthopedics. Dr. Stein is focused on getting patients back to health and, most importantly, ensuring that they prevent the same or similar injury from occurring again. Contact Dr. Benjamin Stein for an appointment.

90,000 indications, price, rehabilitation – Operation to fix the ankle, hip, arm, fingers – Clinic of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow

Fixation of the hand and other joints

Arthrodesis is a surgical operation aimed at completely immobilizing the affected joint, which does not respond to therapeutic treatment and cannot be replaced by endoprosthetics. If such a joint is painful and does not provide support and motor function, it makes sense to consider arthrodesis.It is important to understand that this is an extreme case when other methods are not effective. The lack of friction stops the destruction of the joint and relieves the pain symptom. But after immobilization, the joint grows together forever in one position.

Types of arthrodesis

Depending on the location of the pathology, the patient may be assigned one of the following types of arthrodesis:

• Extra-articular – this type of operation is often performed for tuberculous lesions of the joint and does not involve opening the joint capsule.A special bone graft is used for fixation. After immobilization, the cartilage gradually ossifies.
• Intra-articular – the operation involves opening the joint capsule, the cartilage is removed, and the synovium can also be removed. The bones are fixed in a preselected position using metal plates or pins. This type of operation is the most common.
• Compression – This technique of arthrodesis can be applied to extra-articular and intra-articular protocols.Its essence lies in the fact that the immovable position of the joint is provided with the help of compression-distraction devices (Ilizarova, Grishina, Gudushauri, etc.).
• Mixed – Difficult cases may require the use of both a bone graft and a metal post. Most often, this method is used for multiple destruction of the joints on the foot or pathology of the hip joint.

Indications for conducting

• Arthrosis at the last stage;
• Deforming arthritis due to bone tuberculosis;
• Partial or complete loss of motor function;
• Injuries of flexor tendon, unrecoverable;
• Old dislocations with displacement;
• Inflammatory processes in the joint;
• Deformity of joints due to poliomyelitis;
• “Flaccid joint”;
• Bunion of the big toe;
• Clubfoot.

Contraindications for arthrodesis of the joint

The patient will be denied the operation in the following cases:

• Age up to 12 years (during the period of active growth of the bone apparatus, such operations are contraindicated), as well as over 60 years old;
• Varicose veins, tendency to form blood clots;
• Cardiovascular pathology;
• Presence of purulent-inflammatory processes in the joints;
• Fistulas of unexplained etiology;
• Allergy to anesthesia.

Execution of transaction

The operation is performed under general anesthesia and takes about 2.5 hours. If the patient has contraindications in the form of intolerance to conventional anesthesia, an alternative in the form of epidural anesthesia may be offered. Then he will be conscious during the whole operation.

Depending on the joint in question, arthrodesis has its own protocol, which is important to adhere to as closely as possible.Upon completion of the operation, the patient is transferred to the hospital under the temporary supervision of the medical staff.

Regardless of whether a hand arthrodesis or a foot arthrodesis was performed, the signs of complications must be kept in mind. So, having noticed a change in the color of the skin around the plaster (redness, grayness) or blood spots that have emerged through the bandage, feeling a twitching increasing pain, you should immediately consult a doctor.

Postoperative rehabilitation

When planning an operation, you need to tune in to a rather lengthy recovery process.Rehabilitation after arthrodesis of the joints of the lower extremities or pelvis will take about a year. The fastest rehabilitation period after finger arthrodesis is up to 4 months.

The essence of rehabilitation in any arthrodesis is the need for complete rest of the joint in order to allow the cartilage to be ankylized. For this, plastering is used. Dates of wearing a bandage after arthrodesis:

• ankle joint – 3-5 months, you can walk on crutches at this time;
• knee joint – 3-4 months, without support on the operated leg, you can walk on crutches;
• hip joint – 6-7 months.
• After arthrodesis of the metatarsophalangeal joint , after a few weeks, the patient can walk calmly, provided that special orthopedic shoes with a fixing element are worn.

In order to prevent loss of muscle tone during this period, the patient can be prescribed physiotherapy – laser, magnetophoresis, ultrasound, massage. After removing the plaster cast, it is the turn of physiotherapy exercises. In this case, classes must be carried out under the supervision of a rehabilitation therapist.

Where is arthrodesis of joints done in Moscow?

Specialists of the Central Clinical Hospital of the Russian Academy of Sciences will help patients with destroyed or worn out joints get rid of permanent pain syndrome. Come to the consultation to find out for yourself the possibility of restoring motor and support functions, or to make sure that arthrodesis is the only way to live without pain.

90,000 indications, prices – services of the clinic them. N.I. Pirogov

Arthroscopy is a common method of deep, detailed diagnosis and treatment of joints.It is a minimally invasive surgical intervention through microscopic incisions and punctures, which allows you to accurately determine pathologies and problem areas inside the joint, as well as quickly and with minimal damage to soft tissues to remove cartilage, bone fragments, fluid or purulent exudate. Such an endoscopic operation allows you to restore damaged tendons, ligaments and tissues, restore mobility and performance to the joint, relieving a person of pain. Most often, arthroscopy of large joints is performed – knee and shoulder, but this method is also used to treat ankle, elbow, wrist and other articular nodes.

Arthroscopy: indications and contraindications for the operation

Any joint has a complex anatomical structure, which is why it is not always possible to determine the cause of pathological symptoms using diagnostic equipment. For the purpose of diagnosis, arthroscopic surgery is performed only if other methods cannot establish the nature and cause of the joint disease. In addition, the procedure is often used to assess the condition of the articular node after surgery.

The indications for medical arthroscopy are:

• diseases and injuries of the synovial membrane of the joint;
• cruciate ligament and tendon injury;
• injuries and diseases of the meniscus of a degenerative-dystrophic nature;
• diseases and defects of cartilaginous elements;
• hyperplasia of adipose tissue with its replacement by fibrous tissue, which is often found in Hoff’s disease;
• necrosis of the femoral condyles;
• The presence of free bodies in the joint cavity as a result of intra-articular fractures;
• rheumatoid arthritis;
• pathological changes in intra-articular tissues caused by degenerative processes;
• manifestations of deforming arthrosis;
• joint dislocations.

The operation of arthroscopy has two types of contraindications: general, when it is strictly prohibited, and relative, in which the possibility of surgical intervention is determined by the doctor individually for each patient. General contraindications include:

• pre-infarction and pre-stroke condition, as well as the period after a stroke or myocardial infarction;
• cardiac, renal, pulmonary and hepatic insufficiency;
• arterial hypertension in the acute stage;
• purulent and acute infectious inflammation of the joints;
• unstable condition of the patient due to the severe course of any disease;
• ankylosis of the joint;
• bleeding disorder;
• diabetes mellitus in a state of decompensation;
• toxic damage to internal organs.

Relative contraindications for arthroscopy are:

• internal bleeding;
• depressurization of the joint cavity;
• crushing of soft tissues;
• global damage to the intra-articular cavity.

How arthroscopy of the joints is performed, cost of the operation

Arthroscopy is performed in a sterile operating room equipped with special equipment. A tourniquet is applied to the patient to restrict blood flow to the operated joint.Depending on the intended purpose of the operation, its expected duration, the patient’s susceptibility to certain drugs, the doctor chooses the appropriate type of anesthesia. It could be:

• General anesthesia;
• epidural anesthesia, when the lower body is anesthetized;
• local anesthesia.

Endoscopic arthroscopic surgery is performed as follows:

1. in the area of ​​the damaged joint, the doctor makes two or three micro-incisions with a length of 3-5 mm using a trocar;
2. by puncture, cannulas are inserted into the incision sites – special hollow needles;
3. , a probe and an arthroscope are inserted into the joint cavity, which is a 3-4 mm diameter tube, into which a digital fiber-optic camera with a zoom function is mounted, which allows you to enlarge the image transmitted to the monitor by 40-60 times, and a cold light source.This allows you to diagnose pathology with great accuracy;
4. to improve visibility and reduce the risk of bleeding, an irrigation inert liquid is injected into the studied canal through another cannula;
5. for treatment through an arthroscope, special surgical instruments are introduced into the articular cavity to remove the affected elements or suture connective tissues;
6. at the end of the manipulation, fluid is pumped out of the joint cavity, the arthroscope and cannulas are removed, and a bandage is applied to the puncture site.The operation takes 30 to 60 minutes.

The cost of arthroscopy depends on the degree of complexity of the operation, the type of anesthesia and the duration of the recovery period.

Arthroscopy: possible consequences, recovery and rehabilitation

In most cases, correctly performed arthroscopy does not lead to complications. But sometimes it can be observed:

• the occurrence of infection in the joint capsule;
• bleeding from damaged vessels;
• Injuries to the nerve endings located at the puncture site.

After the arthroscopy operation, recovery occurs quite quickly – the next day the bandage is removed, and a plaster is applied to the puncture sites. Usually, the patient is in the hospital for 1 to 3 days, after which he can return to his usual life.

Athletes or people engaged in physical labor need a rehabilitation period until the joint functions are fully restored. It usually takes about three weeks.

Experienced surgeons of our medical and surgical center in Dnipro will perform arthroscopic surgery at an affordable, competitive price.If you need arthroscopy of the meniscus, as well as diagnostics and treatment of other joints – call and sign up for a consultation at the phones listed on our website!

Joint arthroscopy, meniscus resection in Irkutsk

Arthroscopy, low-traumatic joint operations

Arthroscopy in order to eliminate injuries (treatment) can be performed on any joint and, in particular, meniscus : shoulder, elbow, hip, knee and ankle, wrist.

This method is minimally invasive, that is, it does not require a complete opening of the joint. For the operation, the surgeon makes two punctures through which the endoscope and the surgical instrument are inserted.

The operation usually takes 1 to 2 hours. And recovery after surgery takes 4-5 days on average.

How is the arthroscopy procedure performed?

Preparation for surgery: the patient undergoes general tests and ECG, conducts special studies prescribed by a traumatologist-orthopedist doctor.

Consultation with a surgeon and anesthesiologist, who get acquainted with the patient’s condition (history), test results, talk about the operation and postoperative recovery.

Before the operation, in case of severe anxiety, the patient may be prescribed drugs to reduce psycho-emotional stress.

Anesthesia is applied to each individual. It can be both general and local.

During the operation, the surgeon makes punctures 1-1.3 cm long.Through which instruments and a special fluid are introduced to improve visibility.

After the operation, the patient is admitted to our hospital.

For recovery, each patient is prescribed medications and exercise therapy by the surgeon. In the case of leg surgeries, the use of crutches is recommended at first.

In our clinic, for arthroscopy operations, we use a modern cold plasma koblator Quantum-2 (USA).

It allows you to:

• Ablation – easy cleaning or “brewing” of tissues using cold plasma flow.In the case of joints, this is a delicate treatment of damaged cartilage tissue, such as the meniscus.

• Resection – removal of a part of an organ or tissue.

• Coagulation is a safe stop of bleeding during surgery.

This is possible thanks to special surgical electrodes, which provide cold (up to 50 degrees) plasma for dissecting or “sealing” tissues.

Thus, the surgeon performs all the manipulations quickly, accurately with maximum convenience for himself. For the patient, this means a reduction in the operation time, a quick recovery and a return to normal life.

90,000 Knee meniscus surgery: cost of surgery in Moscow

16 October 2021

Ambulance Yulia Vasilievna

These people give us back the joy of being, allowing us to be happy again.They are professional, hardworking, disinterested and modest, with honor they carry the title of “Man in a white coat” through life. Noli nocere! Words of gratitude: Head of the 3rd Department of Emergency Traumatology, GVKG them. ac. N.N.Burdenko Kerimov Artur Aslanovich, attending physician Igor Vladimirovich Khominets, anesthesiologist Pankratova Ksenia Yurievna and all middle and junior medical personnel of the department. In this profession, there are no random people, only the real, the most … Often dynasties remain in it. Thank you very much and bow for your hard and noble work.You are my precious people, Those who were, who are and who will be, I pray for grace from heaven And I say thank you for everything. Healed Ambulance Yu.V., wife of a reserve colonel. October 2021

10 October 2021

Volkova Svetlana Yurievna

I consulted Darya Aleksandrovna Naida in October 2018, about pain in the knee, after the surgeon’s verdict in the district clinic that I was disabled, the joint was destroyed, my activity was over. Based on the results of Daria Alexandrovna’s consultation: 1.The knee was operated on (arthroscopy of the knee meniscus) – successfully. 2. Rehabilitation is successful. 3. My activity has been restored! (alpine skiing, mountain bike (enduro) – Success! Many thanks for the professionalism, for “immersion in the patient’s life” and for your understanding, for your attentive attitude! Doctor from God! I recommend!

August 16, 2021

Alexey Korabtsev

I want to express my gratitude to the medical specialists of the 3 emergency trauma department, for their treatment, attention, good attitude and understanding.For telling me about each stage of treatment and our further joint actions to restore my health. Thank you so much for your attention, care, understanding. They will always support you with a kind word, and tell you what to do and how, with all the professionalism they do their job and at the same time they will always cheer you up and cheer! Head of the department, Artur Arslanovich Kerimov, traumatologist Boris Vladimirovich Tyulkevich, I would like to express special gratitude to the attending physician, traumatologist Evgeny Anatolyevich Kukushko for the excellent operation.As well as medical brothers: Lapin Oleg Igorevich, Yumashev Nikita Vladimirovich; to nurses Marina Vasilievna fornication, Oksana Mukha. Junior staff: Elena Anatolyevna Balashova, Elena Leonidovna Sablina. Sister mistress Ishutina Nadezhda Leonidovna, senior nurse Shushpannikova Oksana Sergeevna, dressing honey. brother Shelikhov Daniil Dmitrievich. Thank you very much for bringing us back to normal life. Health to you!

August 16, 2021

Alexey Korabtsev

Was in the 3rd trauma emergency department.I want to express my deep gratitude for the treatment, attention, good attitude and understanding, sensitivity, professionalism, humanity in relation to patients. For the fact that they talked about each stage of treatment and further joint actions to restore my health. I would like to express my special gratitude to the department staff: head of the department Kerimov Artur Apslanovich, traumatologist Tyulkevich Boris Vladimirovich, medical brothers: Lapin Oleg Igorevich, Yumashev Nikita Vladimirovich, med. sisters: The Prodigal Marina Vasilievna, Musa Oksana.Junior staff: Balashova Elena Anatolyevna, Sablina Elena Leonidovna, sister hostess: Ishutina Nadezhda Leonidovna, senior honey. sister Shushpannikova Oksana Sergeevna, dressing honey. brother Shelikhov Daniil Dmitrievich. I would especially like to express my gratitude to the attending physician Evgeny Anatolyevich Kukushko. On July 15, 2021, I once again ended up in the 3rd department of the Burdenko hospital. Evgeny Anatolyevich was my attending physician. From the first meeting with him, I felt trust in him. He listened to me very carefully, carefully studied the materials, and approached the preparation of the operation professionally.On July 22, he underwent a complex operation to REMOVE METAL STRUCTURES FROM THE LEFT HIM BONE, EXCUTE SCARS, CORRECTING OSTEOTOMY AT THE HEIGHT OF DEFORMATION. The operation took about six hours. After the operating period went well. Now I’m on the mend. Remembering and strictly adhering to the advice of Evgeny Anatolyevich. Dear honey. staff of 3 departments! Thank you very much for your work in bringing us back to normal life.

06 August 2021

Moiseenko Vladimir Alekseevich

Good afternoon. On September 9, 2020, I underwent surgery on my right shoulder joint. I want to express my deep gratitude to the entire team of the 3 traumatology department (emergency). You are real professionals, God grant you health and long life, so that you can help people and return them to a normal, fulfilling life. Thanks to you, I feel great, I am fully engaged in sports, my hand works in full force.Words cannot convey what you feel. Very, very grateful to everyone.

28 June 2021

Urazbiev Sulumbek Saydievich

Thank you very much for your help. A very good and helpful doctor. I am very pleased with the performed operation. I hope that with the second joint I will get to your hospital.

May 13, 2021

Sergey Gorshenev

Was consulted by Daria Alexandrovna and then operated on with her for a chronic injury.Everything went great, I didn’t even expect it! The doctor did not formally, but scrupulously and thoroughly studied my problem, suggested a treatment plan, performed the operation with high quality and continues to advise me throughout the rehabilitation period. Along with modern medical equipment, I was impressed by the professionalism and well-coordinated work of the entire medical team of the traumatology department. Low bow to everyone who heals people!

May 13, 2021

Sergey Alexandrovich Gorshenev

Was consulted by Daria Alexandrovna Naida and then operated on with her for a chronic injury.Everything went fine, I didn’t even expect it. The doctor did not formally, but scrupulously and thoroughly studied my problem, suggested a treatment plan, performed a high-quality operation, and consulted at the stage of rehabilitation. I was impressed by the professionalism and coordination of the work of the entire medical team of the Department of Traumatology. Low bow!

May 11, 2021

Lyubov Vladimirovna Kondratyeva

I express my deep gratitude to the attending physician Daria Alexandrovna Nayda and the entire team of the center of traumatology and orthopedics for their high professionalism, responsibility and dedication to their work.I myself am a doctor, I came for treatment from Yekaterinburg. On the very first day, a diagnosis was made (different from the guided one), the next day I successfully operated on, at all stages I felt the attention, care and well-done work of the whole team. Low bow to you, be healthy and happy!

01 May 2021

Vyvolokina Olga Stalyevna

Operated twice in the hospital with the attending physician Boris Vladimirovich Tyulkevich. Thank you so much for your professionalism, sensitivity and responsiveness.I would also like to express my gratitude to all the medical staff of the 3rd trauma department.

Andrey Strizhak: “Diseases of the joints are crippling in perspective” – ​​Articles

Excess weight, household injuries, age-related changes – these factors can also lead to various joint diseases. Meanwhile, delaying the treatment of joints is extremely dangerous for health.

What is arthroscopy?

Arthroscopy is called endovideosurgery of the joints of the extremities.Unlike traditional surgery, which uses open abdominal operations, in arthroscopy all manipulations in the joint are performed through micro-incisions. Simply put, this is a gentle method of joint surgery, when both the operation itself and the postoperative recovery of the body take much less time than in traditional surgery. You can also add that today in world medical practice, arthroscopy is recognized as the “gold standard” (the optimal method of examination or treatment – approx.ed.) for the treatment of injuries, injuries and diseases of all kinds of joints – knee, shoulder, ankle, etc.

For what indications is arthroscopy used?

First, with traumatic injuries of the joints – tears of the menisci and intra-articular ligaments, damage to the cartilage, chondral fractures. Most of these injuries are associated with sports. For example, the season of cycling and roller skating has now begun, so the level of injuries has increased significantly – about 70-80% of patients come with sports injuries.

Secondly, arthroscopy is used for orthopedic diseases, for example, septic necrosis, Koenig’s disease. This is when bone necrosis occurs in the joint, the dead area gradually exfoliates and falls out into the joint – the so-called “articular mouse” appears. Such a disease seriously complicates a person’s life, and the most unpleasant thing is that it appears for no apparent reason – due to physical overload, microtraumas that a person does not notice in everyday life. At the same time, young people and even children are susceptible to this disease.

Finally, the third area of ​​application of arthroscopy is degenerative joint diseases. This already applies to the elderly. Often in clinics they are diagnosed with the so-called senile arthrosis – wear of the articular cartilage. However, the cause of pain is not only this – arthrosis is often aggravated by degenerative changes in the joint, which, for example, leads to overweight. For example, a person can sit down and stand up abruptly, which can lead to a tear in the meniscus.

If a person is not injured, but he has pain in the joint, how to determine that surgical intervention is necessary?

Joint pain is the first symptom that should alert a person. If it has arisen, you need to contact a therapist and determine its causes. If it comes to limiting movement and swelling of the joint, then you must immediately contact specialized specialists – traumatologists, orthopedists. I strongly recommend everyone to contact a doctor as soon as possible in case of joint pain.The fact is that injuries and diseases of the joints cripple a person in the long term. It happens that a patient has been treating arthrosis for years, while he has long had a meniscus rupture. Since the meniscus itself does not heal, it begins, like abrasive paper, to vomit the cartilage that connects the joint. And it happens that it puffs up to the bone – I have seen such cases. As a result, arthrosis of the third or even fourth degree occurs, in which treatment is no longer possible – joint replacement is necessary – endoprosthetics.Meanwhile, the person continues to move all this time – the body turns on the compensation mechanism, the pain gradually dulls, and the person gets used to living with it. Over time, people develop a certain stereotype of behavior – even after the operation, they continue to limp for some time, avoid climbing stairs, etc.

How long is the recovery period after surgery?

The timing of recovery also directly depends on how quickly the person asked for help.Well, and, of course, on the degree of damage to the joint. For example, if this is a banal meniscus tear, then recovery occurs very quickly. By the way, if the meniscus rupture occurred recently, then we can sew it. This is called organ-preserving surgery. It is performed using the so-called “everything inside” technique and allows the patient to preserve the meniscus and restore its function. Unfortunately, at a later date, this operation is impossible, since irreversible changes occur in the body of the meniscus. Therefore, I will repeat once again – you need to contact the specialists as soon as possible.

Are there any contraindications for arthroscopy?

The main contraindications are purulent formations, wounds and cuts on the skin at the time of examination of the patient. Well, and the expressed arthrosis already mentioned by me – when only joint replacement can help. Many patients are panicky afraid of any operations, believing that such a radical intervention in the body will harm it even more. What are the risks with the arthroscopy method? There is no need to be afraid of the operation. I said that arthroscopy is the “gold standard” for treating joint diseases.The technique implies a low-traumatic operation and quick rehabilitation – the patient is in the hospital for only 24 hours. Plus, modern medical equipment allows such operations to be carried out efficiently and without risk.

Thanks to modern equipment, we recently began to deal with the so-called cruciate ligament plasty. This is a reconstructive surgery that essentially creates a new anterior cruciate ligament. At the same time, we use two leading American methods – DePuy Mitek and ENDO-BUTTON, based on the use of synthetic and autografts (from the joint’s own tissues).

With all the above described advantages of the technique, I heard that arthroscopy has to be done repeatedly. Is this so, and why is there such a need?

Indeed it is. The fact is that we are eliminating the problem that exists at the moment, but in the future the patient may have a rupture of another meniscus, another ligament. It must be understood that having operated on once, a person does not guarantee himself the health of the joint for life. Repeated injuries, other diseases, and, accordingly, other operations are possible.

Recall that in the clinic of the Russian-Finnish Medical Center TERVE, not only an operation is carried out, but also all the necessary preoperative examinations and a complex of rehabilitation measures.

You can make an appointment with A.P. Strizhak at by calling (391) 205-33-33 or on the website .

90,000 Chondroplasty of the knee joint in Irkutsk at the Expert Clinic

Injuries, excessive physical activity, metabolic disorders, heredity and other causes can seriously affect the condition of the cartilage in the knee joint.Chondroplasty can be helpful in identifying cartilage damage and defects in this area. We asked the doctor – traumatologist-orthopedist of the highest category “Clinic Expert” Irkutsk Aleksey Yuryevich Krasovsky to tell more about this type of surgical intervention.

– Alexey Yurievich, what is chondroplasty of the knee joint?

– This is a plastic surgery performed to replace cartilage defects in a joint. It can be performed both with the use of autologous tissue (the patient’s own tissue), and with the help of bipolymer film.

Chondroplasty helps patients who have a defect in the loaded surface of the cartilage, arthrosis of the second, third degree, but the range of motion is preserved.

– What are the types of knee chondroplasty? What is their difference?

– Chondroplasty at the present stage is carried out endoscopically, that is, using arthroscopy. There are generally three main types of arthroscopic chondroplasty of the knee joint.

1) Abrasive chondroplasty of the knee joint – what is it? This is when, during arthroscopic surgery, abnormal areas of the cartilage that are mobile are removed, create a conflict in the joint and further destroy the articular cartilage.During this operation, both the removal of pathological foci and the stabilization of the edge of the cartilage take place, which prevents its further destruction.

The next stage is the so-called microfracturing, or tunneling of the zones of cartilage defects. The surgeon creates perforations using a needle with a diameter of 1.8 – 2 mm or a special tool (awl for microfracturing). In this case, mesenchymal cells leave the bone marrow. These are red bone marrow cells that fill in defects and promote the growth of fibrous cartilage.

The second point is the use of artificial collagen membranes in abrasive chondroplasty. A collagen membrane is applied to the microfractured surface of the cartilage (in the tunneling zones). It is glued with fibrin glue or sewn with a special seam. This provides ideal conditions for stem cell production and subsequent cartilage repair. That is, mesenchymal cells emerge from the tunneling (or microfractured) holes and cartilage begins to grow under this collagen membrane.

2) The next type is mosaic chondroplasty of the knee joint. Its essence is as follows. Using a special technology, through a small incision (or additional endoscopic ports), a column of cartilage is taken from the unloaded area together with a portion of the bone, and at the same time the same area is taken in the area where there is a defect. After that, they change places. That is, the bone-cartilaginous column from the unloaded zone, where the cartilage of a satisfactory thickness, is transferred to the zone where there is a defect.And the column is transferred from the defect zone to the unloaded zone. Thus, the resulting tissue in the form of a mosaic is transplanted into the damaged area. As a result, the articular surfaces are restored, and the person gets rid of pain.

3) There is also a technique that combines mosaic chondroplasty and collagen membrane. There are dissertations confirming that the use of combined techniques gives a greater effect. However, long-term results indicate that the use of both abrasive chondroplasty and separately mosaic chondroplasty gives quite good results.According to the international standard, for deep cartilage defects, mosaic chondroplasty should be used.

Arthroscopic mosaic chondroplasty of the knee joint can be performed both purely arthroscopically and combined with a small minimally invasive approach.

– Do I need special preparation for knee chondroplasty?

– Preparation, as a rule, consists in the fact that it is necessary to eliminate the inflammatory process, that is, to remove synovitis.Initially, it is possible to carry out sanitation arthroscopy or anti-inflammatory therapy, to achieve weight loss of the patient, to teach him to walk correctly with crutches to relieve the joint.

In my opinion, in the postoperative period it is imperative to use special types of orthoses, which allow unloading certain areas of the loaded surface of the knee joint. The type of orthosis depends on the location of the lesion (in particular, medial, i.e. internal, or lateral, i.e.i.e. the outer part of the knee). Therefore, when choosing, one should be guided by the recommendations of the attending physician.

– How long does rehabilitation take? What is it?

– The duration of rehabilitation after chondroplasty of the knee joint is approximately 6 to 8 weeks. If the patient wears an orthosis, then normal physical activity is allowed to him after 6 weeks. If a person is engaged in physical labor, then, of course, it is necessary to change the way of life. Heavy physical, jumping and shock loads are prohibited.

If we used the so-called film chondroplasty, that is, a special artificial film, then we need to start developing the joint no earlier than a week later. If a patient has undergone another type of chondroplasty, then in principle movement is allowed immediately, but axial loading is prohibited for the first three weeks.

The basic principles of treatment in the postoperative period are that the patient can move the limb as often as he needs, and in full volume, but axial loading is excluded for up to 6 weeks.That is, as much movement as possible, but at the same time prohibiting axial loads. Chondroprotective therapy is also used, and in the late postoperative period, hyaluronic acid preparations, plasmolifting or PRP technologies (introduction of a patient’s blood plasma enriched with activated platelets into the damaged joint) can be used.

– Who is contraindicated for chondroplasty of the knee joint?

– First of all, the procedure is contraindicated in case of purulent or acute inflammatory processes in the area of ​​the knee joint (synovitis), violation of the integrity of the skin.

Chondroplasty is also prohibited in case of fire osteomyelitis, pronounced joint contractures, when there will be no effect with this surgical aid.

A contraindication is the mnestic-intellectual decrease in the patient. That is, when the patient is not in tune and does not understand that in the postoperative period he will need to adhere to a certain rehabilitation plan, and he will not follow all the recommendations. It is better for such patients to refrain from surgery.

Interviewed by Marina Volovik

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For information:

Krasovsky Alexey Yurievich

In 1995 graduated from the medical faculty of Irkutsk State Medical University.
1996–98 – Residency in Traumatology and Orthopedics.
More than 15 years of experience in arthroscopy of joints.
For 12 years he was the chief traumatologist of Irkutsk.
Currently – a doctor – orthopedic traumatologist of the highest category in the “Expert Clinic” Irkutsk. Accepts at the address: st. Kozhova, 9a.

KNEE ARTHROSCOPY | Private clinic “Medic” Cheboksary

What is arthroscopy?

Arthroscopy is a minimally invasive surgical intervention performed using special equipment – an arthroscopic complex.The arthroscope is inserted into the joint through a small puncture in the skin and allows the doctor to perform surgery inside the joint under visual control on a monitor.

Why is arthroscopy performed?

Arthroxopia is used to treat pathology of the knee joints.

During arthroscopy, the doctor examines the knee joint to make an accurate diagnosis and solve this problem.

Indications and contraindications for arthroscopy

Indications for arthroscopic surgery:

• damage to the meniscus;
• cruciate ligament injury;
• inflammation of the synovium;
• patellar displacement;

90,011 articular cartilage defects;

• free bodies in the knee joint

Like all operations, arthroscopy has its contraindications:

• inflammatory processes and purulent wounds;

90,011 ankylosis;

• general serious condition of the patient.

Duration of operation

Arthroscopic surgery takes about an hour. The operation is painless, as it is carried out under the strict supervision of an anesthesiologist.

Rehabilitation period

The postoperative period proceeds quickly due to the fact that the operation is minimally invasive. The patient, on average, within 2 weeks (depending on the pathology) recovers and returns to his usual life.

By the way, after the arthroscopic operation, the connective tissue of the joint is not damaged, and the scars and scars on the skin after healing are practically invisible.That is, the patient should not worry that unpleasant consequences will remain in terms of aesthetics. This is undoubtedly a plus for arthroscopy.

Arthroscopy in Cheboksary

Arthroscopy in Cheboksary is carried out in our clinic by an experienced and professional team of orthopedic traumatologists, together with an anesthesiologist. For this, the most modern equipment and medicines are used.

We have everything to make the patient feel comfortable: cozy wards, constant supervision of a doctor and nurses, attention and assistance of service personnel.If necessary, after surgery, the patient is given crutches for the duration of rehabilitation.

If you need to undergo arthroscopy, call and make an appointment with our orthopedic traumatologists by phone 8 (8352) 23-77-23. Self-registration is available in the MEDIK mobile application or on the website in the Personal Account.

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